Humana, CareSource create alliance to serve dual-eligible population
LOUISVILLE, KY – In late March, Humana, one of the largest providers of Medicare Advantage plans and Medicaid company CareSource, announced a strategic alliance intended to help both companies more effectively manage members that qualify for both Medicare and Medicaid – the “dual-eligible” population.
“The opportunity for managed care companies to effectively serve the dual-eligible population was the conversation starter with Humana,” said Pamela Morris, president and CEO of CareSource. “They have a very large Medicare Advantage and special needs dual-eligible membership – one of the largest in the country. CareSource is very well grounded in the Medicaid space, so we have complimentary strengths, comprehensive skills and competencies that we can offer together to state Medicaid agencies and CMS for managing care for the dual-eligibles.”
The plan is for Humana and CareSource to bid jointly for business, first in Ohio, where CareSource counts the vast majority of its 900,000 Medicaid members, and then also in other states as the opportunities arise.
Currently, more than 20 states are actively working with CMS to create managed care programs directly targeting the dual-eligible population.
For CareSource, the opportunity to work with Humana should provide the impetus for it to broaden its Medicaid footprint to these other states, something Morris noted would have been difficult for the company to do otherwise. But that doesn’t mean there isn’t significant benefit for Humana in aligning with a proven Medicaid company, one of the largest in the country, even though it only does business in a relatively small geographic area.
Kenneth Thorpe, a professor of health policy at Emory University in Atlanta, said that alliances such as this between a Medicare and Medicaid company with a track record in managed care could become much more commonplace as a way to serve the estimated 9 million people who are dual-eligibles.
“You have to remember that most of these people are in an unmanaged, fee-for-service environment, which is about the worst possible system they could be in,” Thorpe said. “They are among the sickest of the sick and there is no one engaging them on keeping them healthy, care coordination and so on.”
It is the coordination of care and combining of disparate skills from the two companies that could be the special sauce for more effectively treating the dual-eligible population.
“Without integration, it is a challenge to manage and coordinate the care of beneficiaries enrolled in both Medicare and Medicaid,” said Michael B. McCallister, chairman and CEO of Humana, in a prepared statement.
It’s a challenge many Medicaid companies are uniquely qualified to meet, according to Thorpe.
“Medicare Advantage plans don’t generally have experience managing things that are non-Medicare services,” noted Thorpe.
Morris added that these other services, that are more community-based and often deal with issues of mental health and substance abuse, are domains where Medicaid plans have much more expertise, and it is a particular area where Medicaid has a lot to give when it comes to finding appropriate care for the dual-eligible population.